Enhanced external counterpulsation (EECP) has been approved by the United States Food and Drug Administration (FDA) for management of refractory angina (Class IIb). EECP uses three sets of pneumatic cuffs that sequentially contract during diastole, increasing aortic diastolic pressure, augmenting coronary blood flow and central venous return. EECP improves anginal symptoms and exercise tolerance, and reduces nitroglycerin use in patients with chronic, stable angina. EECP has also been shown to be safe and beneficial in patients with symptomatic stable congestive heart failure. It has been postulated that cardiac benefits of EECP are mediated though vascular endothelial growth factor (VEGF) and nitric oxide mediated vasodilatation and angiogenesis. In June 2002, the FDA also approved EECP therapy for heart failure patients.

What does EECP do:

· Promotes the growth of smaller vessels around areas of heart muscle lacking in oxygen (ischemia) and causing pain.

· Causes a large rise in chemicals required to “open up” (dilate) the coronary circulation leading to an increase blood supply to the heart. This leads to a decrease in Ischemia and consequently a decrease in pain.

· Increases the pumping ability of the heart and the blood supply to the rest of the body.

· Increases the ability to exercise.

· Decreases shortness of breath.

Applications of EECP:

· Studies have shown EECP is a means of improving perfusion (blood supply) to other organs of the body than just the heart.

· Studies also support a positive clinical benefit for:

o Erectile dysfunction

o Restless leg syndrome

o Tinnitus

· Mild peripheral vascular disease

· Further studies suggest there may well be effective clinical applications for EECP in other pathology such as increasing re-perfusion after:

o cerebral ischaemia (stroke)

o retinal ischaemia

· There is an increasing trend internationally for patients who have significant risk factors such as obesity, strong family history of heart disease, high cholesterol, diabetes, smoking and high blood pressure to undergo self-funded EECP treatment on a prophylactic basis (i.e. before the onset of angina or heart problems).

· There are also applications for sports injury recovery and rehabilitation.